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			Wednesday, March 11, 2009 News Clipping Archives *Maryland / Regional* As revenues slip, O'Malley warns of fresh budget cuts (Baltimore Sun) Sharfstein reportedly an Obama pick for FDA post (Daily Record) FMH embraces information technology (Frederick News-Post) Delegate shares personal story of domestic abuse (Baltimore Sun) St. Joseph reports Legionnaires' bacteria in water supply (Baltimore Sun) Va.'s public mental health care system gets C (USA Today) Va gets $1M grant for uninsured children (USA Today) U.S. Stem Cell Funds Freed; Md. Debates Its Own (Washington Post) *National / International* 21% of Americans scramble to pay medical, drug bills (USA Today) Michelle Obama’s Agenda Includes Healthful Eating (New York Times) Wal-Mart Plans to Market Digital Health Records System (New York Times) Novel Surgery, a Female Condom and Mental Health Failings (New York Times) Tests could detect ovarian cancer early (Baltimore Sun) More evidence prostate tests overdiagnose cancer (Washington Post) *Opinion* Failing families (Baltimore Sun) Maryland / Regional As revenues slip, O'Malley warns of fresh budget cuts Forecast shows half-billion dollar gap; dim outlook puts state workers, tuition freeze at risk By Laura Smitherman Baltimore Sun Wednesday, March 11, 2009 Gov. Martin O'Malley warned yesterday of a fresh round of budget cuts to account for tumbling state revenue forecasts that are far lower than just three months ago, leaving a roughly $515 million shortfall next year. In an interview, the Democratic governor said a tax revenue estimate set for release today is "in essence sending us back to the drawing board" to craft a balanced budget. O'Malley said "it is my hope" to avoid state worker layoffs, and pledged to "do my best to defend" a continued tuition freeze at public universities. But he acknowledged he may revisit those and other budget decisions announced last month amid optimism from the passage of the federal stimulus plan. "We have to look at ways to close a half-billion dollar gap, so we'll have to go back and look at a lot of things," O'Malley said, adding that he had learned how dire the situation had become only 24 hours earlier. "I wish I could share with you exactly how we're going to close this." With the economy declining rapidly, O'Malley and the General Assembly are trying to balance the state's $14 billion general budget with a moving target for how much they can spend. Last month, O'Malley said many deep cuts he had feared would be averted with billions of dollars of new federal aid. O'Malley said then that the federal money would enable him to take budget cuts for public education from kindergarten through high school off the table. Those proposed cutbacks had drawn sharp objections from Baltimore schools chief Andrés Alonso, and yesterday the governor pledged to maintain his commitment to public education. "That investment is critically important to our ability to come out of this recession before other states, and it's going to mean we have a quicker rebound than other states," O'Malley said. The state Board of Revenue Estimates is expected to announce today that tax and other revenue collections have plunged $1.1 billion for this budget year and next. That revenue write-down is far larger than the $600 million over two years that the governor had previously anticipated in his spending plans. The remaining shortfall of about $515 million must be filled mainly through spending reductions or other means. O'Malley, in his proposed budget for the same fiscal year, had already closed a $2 billion budget gap. The state's shifting financial standing has prompted lawmakers to delay action on the budget, said House Appropriations Chairman Norman Conway. "We have postponed our decisions because we need to see the revenue estimates," he said. Legislative leaders, meanwhile, were girding for a budgetary morass. "We're going to have to do some pretty dramatic things in terms of looking at the budget," Senate President Thomas V. Mike Miller said. "We are in a world recession that's ongoing, and we're just going to have to continue dealing with it as best we can." Both Miller and House Speaker Michael E. Bush cast doubt on resurrecting a proposal previously floated by O'Malley to lay off 700 state workers for a savings of about $30 million. "None of us are going to consider layoffs," Busch said yesterday. "Job No. 1 is to keep people in the workforce." Miller has previously suggested that the state might not be able to afford O'Malley's proposal to extend a tuition freeze for a fourth year. Other potential targets include aid to local governments and a proposal to cut salaries for all state employees by 1 percent. Legislative aides have suggested the pay cut could save $53 million, and O'Malley said yesterday the proposal may be part of discussions with legislative leaders. Copyright 2009 Baltimore Sun. Sharfstein reportedly an Obama pick for FDA post By Danielle Ulman Daily Record Wednesday, March 11, 2009 Baltimore Health Commissioner Joshua M. Sharfstein is reportedly the Obama Administration’s pick for deputy commissioner of the Food and Drug Administration. The Wall Street Journal, quoting people familiar with the matter, said that Sharfstein, 39, and Margaret “Peggy” Hamburg, a former New York City health commissioner, are the administration’s top choices for deputy commissioner and commissioner, respectively. Sharfstein’s name often came up as a possible head of the FDA, after he assisted President Barack Obama’s transition team with an assessment of the agency. That chatter had quieted recently as the search for a new leader dragged on for months. According to the Wall Street Journal’s sources, Sharfstein’s candidacy for the top job was strongly opposed by the drug industry lobbyists who reportedly influenced Republicans to oppose him as well. However, as a deputy commissioner he would not need approval from the Senate. Copyright 2009 Daily Record. FMH embraces information technology By Ashley Andyshak Frederick News-Post Wednesday, March 11, 2009 The days of paper medical records have gone by the wayside at Frederick Memorial Hospital. Doctors began using electronic medical records two years ago and they soon will be able to access records and monitor patients over the Internet from their homes or offices. When the system's first phase launches later this month, doctors can remotely access patients' vital statistics, nursing notes, electrocardiograms and radiology images, said David Quirke, FMH's vice president and chief information officer. In the future, the system might incorporate fetal imaging and live access to heart monitors and other bedside equipment, he said. Additions to the system will be based on staff needs. "It's an evolving tool," Quirke said. "We know technology, but the doctors and nurses drive the system." Doctors gathered in classrooms at the hospital last week for an overview of the system, dubbed FMH Clinical Portal. The system gathers information from several sources, avoiding the need to master many computer systems, Quirke said. To ensure patient information is kept secure, doctors will be taught to form strong passwords and all system activity will be traced. Users will be permitted to access the system only from Internet connections at home or in their private offices, Quirke said. Specific access ports will be shut down if the system detects irregular activity. The system eventually could extend to patients outside the hospital. For instance, diabetics could enter blood sugar counts and a list of foods they ate that day for quick evaluation. Quirke said it's unclear how much money from President Barack Obama's economic stimulus package will benefit technology at the hospital. Officials have spent about $13 million on information technology in the past three years, Quirke said, calling it a good investment in the present economy. Such improvements can reduce physicians' workloads and reduce overall health care costs. Starting in the emergency department In the emergency department, patient information is presented on large flat screens so doctors and nurses can monitor patient status and see when lab results are ready. Doctors and nurses agree the system makes their jobs easier. "When (the system) has scheduled downtimes, going back to paper is painful," said Mary Beth Mann, the hospital's director of emergency services. Also in the emergency department, bedside verification ensures that patients receive the right medication at the right time. Before medicine is administered, a nurse scans a barcode on a patient's wristband that must match the barcode on the medication, Quirke said. This technology can reduce medication errors by up to 50 percent, he said. The system will be expanded to other departments beginning next week. Computerized physician order entry, also used in the emergency department, ensures that doctors' orders are clear, Quirke said. This can reduce errors and turnaround time for lab results. The system will expand to about 80 percent of the hospital's patients beginning this summer. This development will put the hospital among 2.5 percent in the United States using this degree of technology in record keeping, Quirke said. Please send comments to webmaster or contact us at 301-662-1177. Copyright 1997-09 Randall Family, LLC. All rights reserved. Do not duplicate or redistribute in any form. The Frederick News-Post Privacy Policy. Use of this site indicates your agreement to our Terms of Service. Copyright 2009 Frederick News-Post. Delegate shares personal story of domestic abuse Victim of domestic abuse urges House to reject bill By Julie Bykowicz Baltimore Sun Wednesday, March 11, 2009 From her seat on the floor of the House of Delegates, a freshman lawmaker from Baltimore rose yesterday to address her colleagues, not as one of them but as a domestic violence victim opposing a measure that would have erased public records of some protective orders. Del. Cheryl D. Glenn, a 57-year-old Democrat, told lawmakers that her husband had horrifically beaten her years ago. She said abuse victims have plenty of reasons not to go to court. In her case, she said, her husband threatened to kill her children. The delegates were considering allowing the subjects of protective orders to have their records expunged if a temporary order is not made final, which can happen if an accuser does not come to court. "I passionately oppose this bill," Glenn said. "I plead with you," she said, to reject it. The legislation failed by five votes, 64 to 69. It was one of numerous - and sometimes seemingly contradictory - domestic violence measures up for consideration this year, including two proposals by Gov. Martin O'Malley that would confiscate guns from the subjects of protective orders. Those bills are up for debate tomorrow in the House, as is a plan to enable those seeking protective orders to carry handguns. Women's advocates said the handgun proposal gives them pause because it could introduce weapons into volatile situations. "We'd go two steps forward and go a step back," said Del. Sue Hecht, a Frederick County Democrat who has been active for more than a decade in domestic violence prevention programs. Hecht also opposed the expungement legislation up for debate yesterday. Del. Luiz R.S. Simmons, a Montgomery County Democrat and trial attorney, sponsored the bill. He said that when temporary protective orders, which judges grant after hearing only from the accuser, don't materialize as final orders, it is only fair to wipe away the public record of the court hearings. "The question before the House is: Innocent until proven guilty - do we believe in it?" Simmons said. Simmons argued that the civil orders are "the equivalent of criminal records" and can be viewed by potential employers and landlords. Even if removed from public view, Simmons said, police officers and courts would have maintained access to the records. He said it was time for lawmakers to address the problem of false accusations of domestic violence. Of the more than 17,000 temporary protective orders granted last year in Maryland, about 9,000 were made final, said Del. Joseph F. Vallario, a Democrat representing Calvert and Prince George's counties and a proponent of Simmons' bill. Opponents, including Glenn, argued that the bill would give abusers another incentive to prevent their victims from going to court. After the voting session yesterday, lawmakers embraced Glenn and thanked her for sharing her story. She said that she had never spoken publicly about her abusive marriage and hadn't thought she would get so emotional in front of her colleagues. Glenn said in an interview that her husband abused her for about four years. After a beating in 1978, she told him she was leaving him and taking her three children to her mother's house in Virginia. She said her husband had a sawed-off shotgun and told her she would never again see the kids alive. But soon after, he accidentally shot himself to death with that same gun. He'd been drinking, she said. Some delegates said yesterday that the bill seemed out of step with other domestic violence proposals they were considering this year. "We have to provide as many protections as possible" to victims of abuse, Hecht said. Copyright 2009 Baltimore Sun. St. Joseph reports Legionnaires' bacteria in water supply By Stephanie Desmon Baltimore Sun Wednesday, March 11, 2009 Employees and patients at St. Joseph Medical Center in Towson are being warned not to use the water at the hospital after routine tests showed the presence of the bacteria that causes Legionnaires' disease in the hot water supply. Hospital officials said the type of Legionella pneumophilia found in the hospital's water is the kind that is less likely to make people sick and that there have been no cases of hospital-acquired Legionella at St. Joseph. Officials said they hope to have the situation remedied within 24 hours. In a letter dated today, patients and employees in the main hospital and new expansion were told they should not take showers or tub baths, drink water from taps or fountains, and use water to wash hands (they can use Purell or waterless soap instead). Meanwhile, employees have been instructed to use saline or sterile water to flush nasogastric tubes and to rinse all patient care equipment with sterile water. People with compromised immune systems are at the greatest risk of sick from the bacteria. Symptoms include pneumonia, cough and fever. Monique Lyle, a spokeswoman for Baltimore County's health department, called Legionella "a fairly common inhabitant of water systems." Copyright 2009 Baltimore Sun. Va.'s public mental health care system gets C Associated Press USA Today Wednesday, March 11, 2009 RICHMOND, Va. (AP) — Virginia received a C from a national report on public mental health care but that's an improvement from two years ago. The report released Wednesday by the National Alliance on Mental Illness says Virginia has made modest improvement since 2006, when the state received a D. The report noted a broadening of Virginia's commitment laws and a $42 million increase in community health services over two years. But the executive director of the alliance's Virginia office says the improvement followed the Virginia Tech shootings. Mira Signer says there is still much work to be done. The grade was based on 65 criteria, including access to medication, housing, peer support, support to National Guard members and housing. Copyright 2009 The Associated Press. All rights reserved. Va gets $1M grant for uninsured children Associated Press USA Today Wednesday, March 11, 2009 NORFOLK, Va. (AP) — A national foundation has awarded a $1 million grant to Virginia to increase enrollment of eligible kids in the state's health insurance program for children. Gov. Timothy M. Kaine announced the four-year grant from the Robert Wood Johnson Foundation on Wednesday. Kaine says Virginia is one of eight states awarded grants. An estimated 120,000 children are eligible for enrollment in the state's Family Access to Medical Insurance Security program, or FAMIS. The program is for children in families who earn too much to qualify for Medicaid, but not enough to afford private insurance. Copyright 2009 The Associated Press. All rights reserved. U.S. Stem Cell Funds Freed; Md. Debates Its Own By John Wagner and Rosalind S. Helderman Washington Post Tuesday, March 10, 2009; B01 President Obama's decision to lift restrictions on federal funding for embryonic stem cell research is certain to rekindle debate in Maryland and a number of other states that moved to pay for the controversial science after the Bush administration's limitation order but are now facing large budget gaps. To try to keep Maryland's vibrant biotechnology sector competitive, state lawmakers have approved $56 million in grants to university and private-sector researchers over the past three years. Gov. Martin O'Malley (D) included an additional $18.4 million in his budget proposal for next year, even as numerous other state programs were cut to close a potential $2 billion shortfall. With Obama's announcement, the legislators, who must act on O'Malley's proposal in coming weeks, were looking anew at whether the state's program is sustainable. Funding has already slowed for similar programs in New Jersey and California. "I think the combination of President Obama's decision and our state budget crisis will put pressure on us to reduce" funding, said Sen. Richard S. Madaleno Jr. (D-Montgomery), a member of the Budget and Taxation Committee, who added that he supports the aims of the research. "It becomes an inviting target because there is now another potential source of funding outside the state." But advocates of the research cautioned against moving too quickly to reduce state money, suggesting that it could be some time before federal dollars become available for embryonic stem cell research, given remaining bureaucratic and legislative hurdles. "In these economic times, I think it's a reasonable question to raise," said Karen Rothenberg, head of the Maryland Stem Cell Research Commission, which awards grants. "But I think it would be premature to pull the momentum and signal to the research community that Maryland is going to walk away from this investment." Eight states -- California, Connecticut, Illinois, Iowa, Maryland, Massachusetts, New Jersey and New York -- have passed programs authorizing spending on embryonic stem cell research since 2001, when President George W. Bush announced that he was limiting federal funding to what turned out to be 21 stem cell lines already in existence at that point. The decision reflected opposition to using taxpayer money in research that involves the destruction of days-old human embryos as a result of extracting the stem cells. Even critics acknowledge that interest in Maryland's program -- which also funds other, less controversial types of stem cell research -- has been strong. During fiscal 2008, the program received 122 applications for funding, of which 58 were approved, including research related to prostate cancer, breast cancer, brain cancer, cartilage repair and liver regeneration. For the current fiscal year, 147 applications, a higher number, were received, but grants have not yet been awarded. Researchers said states such as Maryland that have offered state funding have enabled researchers to make significant strides. Johns Hopkins has been able to purchase equipment and attract top talent in the field, said Valina Dawson, professor of neurology, neuroscience and physiology at the university's School of Medicine. "Maryland money has allowed us to move in new directions that we would not have been able to," she said. At the University of Maryland's Biotechnology Institute, state funds are enabling researchers to collaborate with counterparts in Germany, said W. Jonathan Lederer, professor and director of the institute's Medical Biotechnology Center. This year in New Jersey, which in early 2004 became one of the first states to fund embryonic stem cell research, Gov. Jon S. Corzine (D) cut funding by 75 percent as he worked to close a $3.6 billion budget gap. Today, Corzine will unveil his fiscal 2010 budget, grappling with a projected $7 billion shortfall. Discussions continue about eliminating the funding altogether for the coming year, said Martin Grumet, director of the Rutgers Stem Cell Research Center, which this summer will spend the last of a two-year, $3 million state grant that was used to create three lines of human stem cells. Even the program in California, where voters in 2004 approved a behemoth program funded by $3 billion in bond sales, has been slowed by state budget problems. Alan Trounson, president of the California Institute for Regenerative Medicine, which administers the program, said fighting between the state legislature and Gov. Arnold Schwarzenegger (R) slowed the state's ability to sell bonds. He said the institute now expects to raise $200 million to support the research this year, instead of a planned $300 million. Maryland House Speaker Michael E. Busch (D-Anne Arundel) said it is important that the state maintain its commitment to multiyear research projects that are already receiving state funding. But Busch said it is possible that state funds will be "weaned" in coming years, particularly if the federal efforts prove robust. And efforts by some of colleagues to cut funding could come sooner than that, he acknowledged. The state is scheduled to get updated tax revenue projections tomorrow, which will probably prompt additional cuts to the governor's proposed budget. Legislative analysts have cautioned that the revenue reduction could far exceed $500 million. "Depending on what the revenue estimates are like, people are going to be questioning everything," Busch said. House and Senate budget writers differed yesterday on whether stem cell funding in next year's budget would be significantly reduced. House members said they expect to continue the investment, while senators said the money could be vulnerable. "I would personally hope we don't do that," Lt. Gov. Anthony G. Brown (D) said of possible cuts to state funding as federal dollars come into play. Staff writer Lori Aratani contributed to this report. Copyright 2009 Washington Post. *National / International* 21% of Americans scramble to pay medical, drug bills By Liz Szabo and Julie Appleby USA Today Wednesday, March 11, 2009 Denise Prosser, 39, has battled cancer since she was a toddler. Yet Prosser can't afford her next cancer treatment — a radioactive therapy that she's supposed to receive once a year — because she and her husband lost their jobs in December. Without insurance, she has postponed the radiation indefinitely and is taking only half of her asthma medications — sacrifices that often leave her gasping for air and could allow her cancer to come surging back. "I can't walk more than 100 feet without sounding like I just ran a marathon," says Prosser, of Galloway, N.J. Prosser is among millions of Americans who struggled last year to pay for health care or medications, the largest poll ever conducted by Gallup shows. As the economy fell, the percentage who reported having trouble paying for needed health care or medicines during the previous 12 months rose from 18% in January 2008 to 21% in December, according to the poll of 355,334 Americans. Each percentage point change in the full survey represents about 2.2 million people, says Jim Harter, Gallup's chief scientist for well-being and workplace management. Gallup, along with disease management company Healthways, surveyed a random sample of about 1,000 people nearly every day during 2008 about their physical, emotional and economic well-being. The poll, the Gallup-Healthways Well-Being Index, shows that struggles to pay crossed all socioeconomic lines but hit some Americans harder than others: More than half of the uninsured had trouble paying for health care or medications during the year. So did more than 30% of blacks and Hispanics, compared with 17% of whites and 13% of Asians. Overall, women had more trouble than men. Those who were divorced, widowed or in domestic partner arrangements fared less well than those who were married. Among other key findings: • As the year progressed, fewer Americans reported getting health coverage through their jobs, dropping from 59% in the first quarter to 58% by the last. • The number of African Americans reporting trouble paying for health care or medications rose six percentage points from the first quarter to the last, to 34%. People ages 25-34 also saw a big increase, up five points to 28%. • Among the states, Hawaii had the smallest percentage of residents who had trouble paying for health care in the previous 12 months at 12%, and Mississippi the most at 29%. "The biggest problem that the country has is actually the cost of health care," says Jim Clifton, Gallup's CEO. "It's a lot bigger problem than war and a bigger problem than the current meltdown because there are no fixes to it on the horizon right now. … You can't just throw money at it. That's still not a fix." The increasing trouble people have paying for medical care comes as Congress begins its most serious health care overhaul debate in 15 years — and as the economy continues to shed jobs. Because most people still get health insurance through their jobs — rather than buying it themselves or being covered by a government program such as Medicare — the loss of a job can mean the loss of insurance. Nearly 4.4 million people have lost jobs since the recession began in December 2007, the U.S. Department of Labor reports. Nearly one in 10 children and one in five adults under age 65 are uninsured, says a February report on the uninsured from the Institute of Medicine, part of the National Academy of Sciences, which advises the government on health care. People without insurance are at much higher risk for a host of medical problems, the institute's report shows. They're less likely to get preventive care, more likely to be diagnosed with later-stage cancers and more likely to die if they suffer a heart attack, stroke, lung problem, hip fracture, seizure or trauma. "The evidence clearly shows that lack of health insurance is hazardous to one's health," says report co-author Lawrence Lewin. "And the situation is getting worse." Lower-income residents are more likely to have trouble paying medical bills and to lack insurance. Income also plays a role in how people feel about their own physical well-being. The Gallup-Healthways poll found that 40% of those making $500 to $1,000 a month said they were dissatisfied with their health. By comparison, only 10% of wealthy people — those making at least $10,000 a month — are dissatisfied with their health. Few safety nets People often resort to desperate solutions to pay for health care for themselves and their families, says Christy Schmidt, senior policy director at the American Cancer Society's Cancer Action Network. Some are tapping into their 401(k) plans and other retirement savings, she says. But even these funds may fall short, since many investments have lost half their value in the past year. When money gets really tight, Schmidt says, many uninsured people cut corners on their health, such as by cutting pills in half or skipping doctor's appointments. While Gallup's poll asked if the specific person being interviewed had cut back on "needed" health care, a February poll by Kaiser Family Foundation took a broader look at health care spending. In that poll, more than half of Americans said at least one person in their family had cut back on medical care within the previous 12 months because of cost. Many people can't pay for coverage on their own, Schmidt says. Among them are Denise Prosser, who worked part time in a day care before being laid off, and her husband, Warren, who was a television news director in Linwood, N.J. The 600 stitches on her back testify to her long struggle with cancer. She was first diagnosed at 18 months old. A new tumor, in her thyroid, developed when she was 27. Her lung capacity has declined by 50% since then as her health has deteriorated, leaving her unable to work full time. The Prossers say they can't afford coverage through COBRA, a program that allows workers to keep their health insurance for 18 months after they leave their jobs, just as long as they pay 100% of the health premiums themselves. A COBRA plan would cost the Prossers $900 a month, Denise says. With help from the recently passed economic stimulus package, which provides a federal subsidy worth 65% of COBRA premiums, the Prossers still would have to pay $300 a month — an especially high price tag for people who no longer have regular salaries. After she lost her job, Prosser applied for official status as disabled through the Social Security Administration but was turned down: "They said I wasn't disabled enough." Even patients who qualify as disabled may struggle with medical bills, Schmidt says. Most people have to wait two years after being declared disabled before they qualify for Medicare coverage. If patients opt for 18 months of COBRA, that still leaves a six-month gap. That puts Prosser — whose doctor recently found a lump on her thyroid — in a sort of no man's land. Prosser fears the lump could be a relapse of the thyroid cancer she developed in 1997. Although her thyroid specialist gave her some free medication samples, the doctor would not treat Prosser without insurance. Prosser hopes to see a doctor through a charity clinic in Atlantic City but worries her husband's income from his unemployment check — $622 a week before taxes — may disqualify them. A domino effect Even charity care and emergency rooms can't guarantee that uninsured people — especially those such as Prosser, who have a long history of complex problems — get the treatment they need, says John Ayanian, a Harvard Medical School professor and co-author of the Institute of Medicine report. Free clinics often struggle just to find generalists, he says, let alone specialists. The problem extends beyond individual struggles. Eroding insurance coverage can undermine the health of entire communities, Ayanian says. Hospitals and doctors may have trouble paying their own bills in communities with large numbers of uninsured. That can drive away specialists and make it harder for even well-insured people to find care, the report says. Often, people without insurance must struggle on their own. Calls to the cancer society's insurance hotline have increased by 6% since last year, Schmidt says. Although the society sometimes can help patients find coverage, three out of five callers find those options — such as individual health policies or state-sponsored high-risk pools — too expensive, Schmidt says. Nor is there any guarantee those options will be available. Individual policies sometimes won't cover pre-existing medical conditions, such as cancer, depression or pregnancy, or will not pay for care needed for those conditions during an initial period of six months or more. Dropping insurance Jim Hann, 51, who's losing his job as a chemical operator at the Americas Styrenics plant in Marietta, Ohio, next month, won't be able to afford COBRA, even with the federal subsidy. The plant is laying off 65 of 100 employees. That didn't deter him, however, from donating a kidney to his wife, Hannah. In the past decade, Hannah has weathered more surgeries than they can count: seven or eight operations to cut away dying sections of bowel, a small intestine transplant and, in February, the kidney transplant at Washington's Georgetown University Hospital. "He tells me he'd give me both of his if that's what it took," says Hannah, 49, a few days after the February transplant. Their surgeon moved up her transplant surgery by a month, before Jim's coverage lapsed. Although Hannah's disability makes her eligible for Medicare, she has used Jim's generous company-funded insurance until now. Medicare will cover her health care after Jim loses his coverage in November. Jim plans to get by without any insurance. That's a gamble, given that kidney donors have an increased risk of high blood pressure and kidney problems. After taking care of Hannah for so many years, Jim says he's well-prepared for his next career. He has decided to enroll in a nursing program that will make him a registered nurse within two years. Until then, he says, the couple will "tough it out" by living off their savings, Hannah's disability check and the proceeds they make selling their home to move into a smaller, cheaper house. If needed, Jim says he's prepared to return to driving a truck or waiting tables while going to school. But he doubts he'll ever find another job like the one he lost. Factories are laying off at least 1,000 workers in the region around Marietta and Ravenswood, W.Va., about 50 miles away, where Century Aluminum is shutting down a plant and letting go about 600 employees. The Gallup-Healthways survey found nearly 25% of people in the congressional district that includes Marietta didn't have enough money to pay for health care in the past year. "There aren't even any bad jobs," Jim says. "It's the same all over." Contributing: Susan Page Copyright 2009 USA Today. Michelle Obama’s Agenda Includes Healthful Eating By Rachel L. Swarns New York Times Wednesday, March 11, 2009 WASHINGTON - THE television cameras were rolling, the journalists were scribbling and the first lady, Michelle Obama, was standing in a soup kitchen rhapsodizing about steamed broccoli. And homemade mushroom risotto. And freshly baked apple-carrot muffins. Mrs. Obama was praising the menu last week at Miriam’s Kitchen, a nonprofit drop-in center serving this city’s homeless. And she seized the moment to urge Americans to provide fresh, unprocessed and locally grown foods to their families and to the neediest in their communities. “You know, we want to make sure our guests here and across the nation are eating nutritious items,” said Mrs. Obama, who served lunch to several homeless men and women and delivered eight cases of fresh fruit to the soup kitchen, all donated by White House employees. “Collect some fruits and vegetables; bring by some good healthy food,” she said. “We can provide this kind of healthy food for communities across the country, and we can do it by each of us lending a hand.” In her first weeks in the White House, Mrs. Obama has emerged as a champion of healthy food and healthy living. She has praised community vegetable gardens, opened up her own kitchen to show off the White House chefs’ prowess with vegetables and told stories about feeding less fattening foods to her daughters. White House officials say the focus on healthy living will be a significant item on Mrs. Obama’s agenda, which already includes supporting working families and military spouses. As the nation battles an obesity epidemic and a hard-to-break taste for oversweetened and oversalted dishes, her message is clear: Fresh, nutritious foods are not delicacies to be savored by the wealthy, but critical components of the diets of ordinary and struggling families. It is a notable shift in direction. The former first lady, Laura Bush, insisted that fresh, organic foods be served in the White House, but did not broadcast that fact to the public, according to Walter Scheib, who served as executive chef under Presidents Bill Clinton and George W. Bush. “She just didn’t talk much about it outside the house,” Mr. Scheib said of Mrs. Bush. “Mrs. Obama is taking a higher profile.” In a speech at the Department of Agriculture last month, Mrs. Obama described herself as “a big believer” in community gardens that provide “fresh fruits and vegetables for so many communities across this nation and world.” A few days later, she invited television cameras into the White House kitchen and made a point of praising the chefs’ nutritious creations, including creamed spinach without the cream. Mrs. Obama presented herself not as a celebrity who has appeared on the cover of Vogue — though, of course, she has appeared on the cover of Vogue — but as a down-to-earth mom who works hard to keep in shape and to please the palates of her two daughters, Sasha, 7, and Malia, 10, who sometimes wrinkle their noses at the greenery on their plates. “It’s like: How do we keep the calories down but keep the flavors up?” said Mrs. Obama, who also praised a healthy broccoli soup prepared by White House chefs. “That’s one of the things that we’re talking a lot about,” she said. “When you grow something yourself and it’s close and it’s local, oftentimes it tastes really good. “And when you’re dealing with kids, for example, you want to get them to try that carrot. Well, if it tastes like a real carrot and it’s really sweet, they’re going to think that it’s a piece of candy. So my kids are more inclined to try different vegetables if they’re fresh and local and delicious.” The secret to that creamless creamed spinach? Sautéed spinach, olive oil and shallots are whipped into a purée that is light and delicious, according to Cristeta Comerford, the White House executive chef. Even so, Mrs. Obama conceded, the dish was not a hit with Sasha. No matter what you do, she said ruefully, “sometimes kids are like, ‘It’s green!’ ” Some of those who had called on President Obama to use the White House as a bully pulpit to help improve Americans’ eating habits are cheering Mrs. Obama on. They were thrilled to learn that the White House gets fresh fruits and vegetables from farms in Maryland, Pennsylvania and New Jersey. And they delighted in the news that the Obamas had served organic wine at their first big White House dinner, a gathering of the nation’s governors last month. Danny Meyer, the restaurateur, praised Mrs. Obama for speaking “in real human terms about what kind of choices real human beings can make in terms of their own lives.” Ruth Reichl, the editor of Gourmet magazine, said she was impressed to see Mrs. Obama showcase a soup kitchen that serves only fresh food — nothing canned or processed — to the poor. “They’re not just saying, I want to feed my family this; this is good for us,” said Ms. Reichl of the Obamas. “Clearly Mrs. Obama is making a point. She thinks communities across the nation deserve to have access to fresh fruits and vegetables.” In addition to speeches, Mrs. Obama is also spreading the word through interviews with celebrity and parents’ magazines. In the March 9 issue of People magazine, for instance, the first lady described her early morning workouts with the president and bared her famously toned arms on the cover. And in the November issue of Parents magazine, she and her husband described their decision to ditch juice boxes and processed foods. “A couple of years ago — you’d never know it by looking at her now — Malia was getting a little chubby,” Mr. Obama told the magazine. They took action, Mrs. Obama said, when “her doctor — he really monitors this type of thing — suggested we look at her diet. So we cut out juice boxes, sweets and processed foods.” Advocates for healthy food and living want the Obamas to do even more. Ms. Reichl would like the White House kitchen to issue regular news releases that describe what the first couple and their daughters are eating. (Then parents across the country could tell their children, “You know, Malia and Sasha were eating salad yesterday. ...”) Roger Doiron, founding director of Kitchen Gardeners International, a nonprofit group, is one of several people who want the Obamas to plant an edible garden that would serve as a national model. Mr. Scheib cautioned that no one should expect the Obamas to upend their lifestyle. “This is not to say they’re going to be eating rice cakes and tofu three meals a day, not at all,” he said. In fact, Mrs. Obama cheerfully admits to an occasional hankering for fast food. It’s all about eating in moderation, she said, emphasizing the kind of flexibility that might make it easier for people to relate to her message. Last month, the first lady took her staff out to lunch at Five Guys Burgers and Fries, a hamburger chain, where she had a cheeseburger, fries and a Coke. (No, not a Diet Coke.) Mrs. Obama also enjoys waffles and grits for breakfast, though not every day. And she said that the White House chefs, who can make nutritious meals tasty, have other talents as well. “They can also make a mean batch of French fries when you want it done,” she said. Copyright 2009 New York Times. Wal-Mart Plans to Market Digital Health Records System By Steve Lohr New York Times Tuesday, March 11, 2009 Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine. Wal-Mart’s move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package. The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half. “We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.” The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates. Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members. And the company’s research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam’s Club. The financial incentives in the administration plan — more than $40,000 per physician over a few years, to install and use electronic health records — could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and improve care. But many, especially physicians in small offices, doubt the wisdom of switching to electronic health records, given their cost and complexity. Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published last year in The New England Journal of Medicine. The use of electronic health records is widespread in large physician groups, but three-fourths of the nation’s doctors work in small practices of 10 physicians or fewer. Wal-Mart, however, has the potential to bring not only lower costs but also an efficient distribution channel to cater to small physician groups. Traditional health technology suppliers, experts say, have tended to shun the small physician offices because it has been costly to sell to them. Taken together, they make up a large market, but they are scattered. “If Wal-Mart is successful, this could be a game-changer,” observed Dr. David J. Brailer, former national coordinator for health information technology in the Bush administration. In the package, Dell is offering either a desktop or a tablet personal computer. Many physicians prefer tablet PCs because they more closely resemble their familiar paper notepads and make for easier communication with the patient, since the doctor is not behind a desktop screen. EClinicalWorks, which is used by 25,000 physicians, mostly in small practices, will provide the electronic record and practice management software, for billing and patient registration, as a service over the Internet. This “software as a service” model can trim costs considerably and make technical support and maintenance less complicated, because less software resides on the personal computer in a doctor’s office. Dell will be responsible for installation of the computers, while eClinicalWorks will handle software installation, training and maintenance. Wal-Mart is using its buying power for discounts on both the hardware and software. Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said. The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians. “That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said. Copyright 2009 New York Times. Novel Surgery, a Female Condom and Mental Health Failings Morning Rounds By Roni Caryn Rabin New York Times Wednesday, March 11, 2009 U.S. Still Lags in Mental Health Care, Group Says An advocacy group gives the United States a "D" on its mental health care report card, CNN reports. The National Alliance on Mental Illness says the country has made only marginal progress in serving the mental health needs of adults since its last report card three years ago, which also gave the country a "D." Girl Returns Home After Extensive Cancer Surgery A seven-year-old girl left a New York hospital to go home yesterday after an operation in which doctors removed six vital organs so they could take out a cancerous tumor, USA Today reports. Heather McNamara of Islip Terrace, L.I., underwent a 23-hour operation in which surgeons at New York-Presbyterian Morgan Stanley Children's Hospital temporarily took out her stomach, pancreas, spleen, liver and intestines in order to remove the tumor. The cancer had damaged her pancreas, spleen and stomach, and surgeons created a replacement for her stomach from her intestines. F.D.A. Approves New Female Condom The Food and Drug Administration has approved a new, less expensive female condom, Reuters reports. The new design makes for quieter use, and officials from Female Health Co. say they hope the lower cost of the new condom will make it easier to distribute in Africa and other parts of the world where H.I.V. is rampant. Calif. Officials Decline to Mandate Autism Therapy Parents of autistic children in California were dealt a setback yesterday when regulators ruled insurance companies must pay for speech, occupational and physical therapy, but not for a behavioral therapy that helps autistic children function in society, The Los Angeles Times reports. Parents were fighting to have the therapy, which can cost $70,000 a year, covered by insurance. Copyright 2009 New York Times. Tests could detect ovarian cancer early Associated Press By Maria Cheng Baltimore Sun Wednesday, March 11, 2009 LONDON - Doctors screening women for ovarian cancer were able to pick up the disease about two years earlier than normal, according to a British study published today. Scientists have long searched for a way to identify ovarian cancer early, which kills nearly 100,000 women worldwide every year. If it is found early, nearly 90 percent of women survive. However, most women are currently only diagnosed with the disease after it has spread, when there is only a maximum 30 percent chance of survival. In the British study, doctors enrolled approximately 200,000 post-menopausal women aged 50 to 74 across the United Kingdom from 2001 to 2005. About 100,000 of those women received no screening tests. The remaining half were split into two groups. Roughly 50,000 were screened with a blood test. If the blood test results suggested an abnormality, they then had an ultrasound. The rest of the women, nearly 50,000, received an ultrasound only. In the women who had a blood test first, researchers found 38 who had cancer. In those who only had an ultrasound, there were 32 cancer cases. Using the blood test method, ovarian cancer was picked up 89 percent of the time. With the ultrasound, the rate was about 75 percent. In these preliminary results, doctors found nearly half of the cancers detected were at an early stage. Normally, doctors would only catch about 15 percent of early ovarian cancer patients. The study was published online today in the medical journal, Lancet Oncology. "I'm cautiously optimistic," said Robert Smith, director of cancer screening at the American Cancer Society. Smith was not connected to the study. "This may make a difference to saving lives, but we don't know that right now," he said. Smith said the tumors detected in screening are sometimes not the ones that kill. To know if catching ovarian cancer early saves lives, researchers must wait until the study finishes in 2014 to look at all the data. The study was mainly paid for by Britain's Medical Research Council, Cancer Research UK and the Department of Health. "Picking up cancer early is a prerequisite to saving lives," said Ian Jacobs, one of the study's authors and dean of health sciences research and director of the Institute for Women's Health at University College London. "But the question is, is this early enough?" Experts will also have to weigh the tests' benefits against its costs. "It's a big and expensive jump to decide that (national) screening programs might be beneficial," Smith said. With any screening test, authorities must determine whether the tests save enough lives to merit the financial and other costs, like patients who will have unnecessary surgeries or psychological distress. Several companies in the United States are seeking approval from the Food and Drug Administration to sell their tests. Copyright 2009 Baltimore Sun. More evidence prostate tests overdiagnose cancer Associated Press By Lauran Neergaard Washington Post Tuesday, March 10, 2009 WASHINGTON -- As many as two of every five men whose prostate cancer was caught through a PSA screening test have tumors too slow-growing to ever be a threat, says a new study that raises more questions about the controversial tests. The work "reinforces the message that we are overdiagnosing prostate cancer," said Dr. Len Lichtenfeld of the American Cancer Society, who was not involved in the new study. More than 186,000 U.S. men will be diagnosed with prostate cancer this year, and nearly 29,000 will die, according to cancer society estimates. Most men over 50 have had a blood test that measures prostate specific antigen, or PSA, mostly for routine screening. There begins the list of problems: Most men who undergo a biopsy for an abnormal PSA test don't turn out to have prostate cancer; high PSAs often signal a benign enlarged prostate. Of those who do have cancer, there's no proof yet that early detection saves lives _ as most prostate tumors grow so slowly that had they not been screened, those men would have died of something else without the anxiety. How many? Estimates vary widely. Enter the new study, which tracked prostate cancer diagnosed in U.S. men ages 54 to 80 between 1985 and 2000, and used three different models developed by cancer centers to more accurately estimate overdiagnosis. Depending on how it's calculated, anywhere from 23 percent to 42 percent of PSA-detected cancers would otherwise never have been detected in the man's lifetime, concluded the team led by researchers at Erasmus University Medical Center in the Netherlands. The study was published online Tuesday by the Journal of the National Cancer Institute. Why is overdiagnosis such a concern? Because finding an early tumor forces men to choose among contested treatments _ "watchful waiting," surgery, hormone therapy, radiation. And because some treatments can cause incontinence and impotence, men whose tumors wouldn't have been a threat can suffer serious side effects for no gain. In fact, national health guidelines issued last year said men over age 75 shouldn't undergo PSA screening, while younger men should make an individual choice after hearing the pros and cons and weighing their own cancer risk. The new study's estimate of U.S. overdiagnosis probably is too low _ because since 2000, doctors have begun performing biopsies for lower PSA levels than once were the trigger, wrote Dr. Michael Barry of Massachusetts General Hospital in an accompanying editorial. It's a confusing issue, acknowledged the cancer society's Lichtenfeld. It boils down to: "If we diagnose this disease, are we making your life better? We know that for other cancers," such as breast, cervical and colorectal, which have strong evidence showing early detection hugely improves survival, he said. Major studies are under way that in a few years should offer better guidance for prostate cancer screening, and scientists are furiously hunting new tests that might help pinpoint who has a worrisome tumor and who can relax. "We're waiting for that evidence. Hopefully we'll have it in the not too distant future, but we really don't have the best answer right now," added Lichtenfeld, who stressed the importance of discussing potential benefits and risks with a doctor. © 2009 The Associated Press. *Opinion* Failing families Immigration enforcement policies unfairly hurt many children who are citizens By Lavanya Sithanandam Baltimore Sun Wednesday, March 11, 2009 When I walked into the exam room, I knew something was wrong. My 8-year old patient, usually an extroverted, charming boy, was angry. He sat with his arms crossed and refused to look at me. His exhausted mother recounted how one week ago, her husband, after arriving home from a 12-hour shift at work, had been arrested in front of his children and taken away in handcuffs. He was now sitting in an Immigration and Customs Enforcement (ICE) detention center in Frederick. The mother asked me to evaluate her son for a one-week history of poor appetite, difficulty with sleeping, and wheezing. As a pediatrician working in Montgomery County, home to the largest immigrant community in Maryland, I have seen firsthand the devastating effects that aggressive immigration enforcement policies can have on families. Many of these children are citizens, born in the United States to at least one undocumented parent. Yet these children often experience what no U.S. citizen (or any child, for that matter) should. They live in constant fear of abandonment because they have seen and heard of neighbors and family members being picked up and deported within days. My patient, a "citizen child" himself, was exhibiting symptoms of depression, and like other children who have lost a parent to detention centers, he perceives his father's arrest as somehow being his fault. His mother, who must now take over her husband's 15-year role as the family's breadwinner, is struggling to pay the bills, to make the lengthy drive to see her husband, and to take her son to the doctor. These parents are good people: hardworking and honest immigrants from West Africa who pay their taxes and take good care of their children. They struggle to make a decent life for their family, despite a grueling, 70-hour workweek. Unfortunately, their story is not unique. There are more than 5 million citizen children in this country - and sadly, the likelihood that one or both of their parents will be deported is increasing. In order to meet arrest quotas, ICE agents are increasingly going after "soft targets": immigrants such as my patient's father, with no criminal record and for whom ICE had not issued a deportation order. Some of these people are picked up by chance, at work or at home. Some are victims of "residential raids" where immigration authorities knock on door after door with no evidence that the inhabitants are undocumented until they can get someone to admit that he or she is here illegally. Sometimes, racial profiling is an issue - as in the case, recently revealed, of a January 2007 raid on a 7-Eleven in Baltimore. Officers detained 24 Latino men, few of them with criminal records, in an apparent effort to meet a quota for arrests. The future for families like my 8-year-old patient's looks grim. My patient's suffering will probably have no influence on his father's deportation proceedings, given the high legal standards of "extreme hardship" that must be met in order for his father to stay with his family. The boy will most likely be forced to start a new life in a country he has never even visited. Immigration policy is complicated and emotionally charged, but punishing citizen children should be at the bottom of ICE's priorities. It is time to once again consider a fair and comprehensive approach to immigration reform. One promising proposal is the "Child Citizenship Protection Act" (introduced this year by Rep. Jose Serrano of New York), which would authorize an immigration judge to prevent deportation of an immigrant when it is in the best interest of his or her citizen children. It is essential to enact laws that will promote family reunification, fairness and dignity over current enforcement tactics that tear families apart. Dr. Lavanya Sithanandam, a pediatrician in Takoma Park, immigrated to this country from India at the age of 4. She is a member of South Asian Americans Leading Together (SAALT), a social justice and advocacy group. Her e-mail is drsithanandam@gmail.com. Copyright 2009 Baltimore Sun. BACK TO TOP


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